Anatomical bases of the latissimus dorsi flap to close of cerebrospinal fluid fistulas

Abstract

Cerebrospinal fluid (CSF) fistulas are a real problem for their resolution. Due to the formation and constant pressure, added to the effect of the liquid on the tissues where the fistula is located, they do not close. Repair of the meninges must be carried out (generally with synthetic materials) and it is also necessary to provide vital tissues for definitive closure. Among the options described is the latissimus dorsi musculocutaneous or myocutaneous flap (LD flap) – musculus latissimus dorsi (TA) for the immediate reconstruction of dorsal defect fistulas, providing a good volume of tissue. The flap bases its circulation on the primary pedicle (subscapular vessels) with mobilization of the muscle towards the dorsal column. The present work presents the anatomical principles in fresh dissections of the LD flap. Detailed dissections of the pedicles that supply the flap are shown, as well as surgical bases to elevate the flap and transpose it towards the dorsal region. A clinical case is presented where LD flap was successfully used to close a cerebrospinal fluid fistula after oncological surgery for a dorsal column tumor